The primary purpose of the proposed research is to challenge the underlying assumption that the traditional straightforward recitation of the facts is the optimal way to convey health-related information. Years 1 and 2 focus on understanding existing cancer portrayals by analyzing the frequency and type of cancer depictions on the 10 most popular primetime television programs. To assess the impact these primetime portrayals have on between 10 to 20 million viewers each week, we will be working with Hollywood, Health and Society and the television networks to identify upcoming episodes involving breast and cervical cancer. By measuring any change in viewers'cancer-related knowledge, attitudes and behavior before and after these episodes air, we can determine the key elements that make a story or narrative more or less effective. In Year 3, we empirically test whether utilizing a narrative format produces a greater and longer lasting impact on cancer knowledge, attitudes and prevention behavior. Four hundred females between the ages of 25-65 with no pre-existing cancer history will be presented with an animated narrative involving a young woman who is diagnosed with cervical cancer (the experimental narrative condition). The same factual information will be presented to another 400 women in the non-narrative control condition. Because we also question the assumption of a "one- size-fits-all" message strategy our sample will be equally divided among four ethnic groups - African Americans, European Americans, Korean Americans and Mexican Americans - all of whom are at elevated risk for breast or ovarian cancer. In addition to cultural differences, we predict that narratives may be particularly effective for cultures with a strong oral history, for recent immigrants, for older generations, and for those with low literacy. We will add context and depth to these findings by using qualitative techniques such as focus groups and consulting with medical anthropologists to further understand how women of different ages, ethnicities, acculturation and education levels understand cancer, its cause, prevention and treatment. In Year 4, we examine the effect of communication modality to determine which communication channel or channels might produce the strongest and longest lasting changes in information retention and motivation. More specifically, we will conduct a field experiment in which a fresh sample of 800 females will be randomly assigned to the same cancer narrative but 200 (50 of each ethnicity) will be exposed to the narrative in a print format, 200 in an audio format (similar to radio), 200 in an audiovisual format (similar to television or YouTube), and 200 in an interactive format requiring responses from the individual (similar to a videogame). This design will allow us to test whether the effectiveness of a narrative may vary as a function of channel and whether there is an interaction between modality and key demographic factors such as generation, level of acculturation and education. In sum, each of these methodological tools provides an important piece to the overall puzzle of how to best convey health information to increasingly diverse audiences. ) PUBLIC HEALTH RELEVANCE: The proposed research challenges the assumption that a traditional straightforward recitation of the facts is the optimal way to convey health-related information and empirically tests whether utilizing a narrative format might produce a greater and longer lasting impact on knowledge, attitudes and prevention behavior. We also examine the effect of communication modality (i.e., print, audio, audiovisual, interactive) on attention, behavior change, and retention of cancer- relevant information. Although the proposed research will focus on breast and cervical cancer, the results have clear implications for virtually all health care communication and could radically change how health messages are conveyed across different ethnic groups, generations and modalities. ) )